HomeMy WebLinkAboutProject Completion Affidavit - Lafayette Building Exterior Masonry Renovations Div B Project No 117-100R - C&S Masonry Restoration LLC1316 COUNTY-CrTY BUILDING
227 W.JEFFERSON BOULEVARD
SOUTH BEND- INDIANA 46601-1930
,OU 1" J
PEACE
186,5
CITY OF SOUTH f
BOARD OF iWORKS
June 25, 2019
Steve Fields
C&S Masonry Restoration LLC
3725 N. Foundation Court, Suite AB
South Bend, IN 46628
PHONE 574/235-9251
FAX 574/235-9171
RE: Project Completion Affidavit — Lafayette Building Exterior Masonry Renovations,
Division B — Project No. 117-100R
Dear Mr. Fields:
The Board of Public Works, at its meeting held on June 25, 2019, approved the Project
Completion Affidavit for this project in the amount of $284,045.
A copy of the Project Completion Affidavit is enclosed for your records.
If you have any further questions regarding this matter, please call this office at (574) 235-
9251.
Sincerely,
Linda M. Martin, Clerk
Enclosure
GARY A. GILOT GENEVIEVE E. MILLER ELIZABETH A. MARADIK LAURA L. O'SULLIVAN THERESE J. DORAU
PROJECT NAME
PROJECT NO
CONTRACT SIGNED
PROJECT DESCRIPTION
WITNESSETH:
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKSi1
PROJECT COMPLETION AFFIDAVIT ,
Lafayette Building,Exterior Renovations Mason
117-100R Division B FINAL COST $284,045.00
10/18/2018 MAINTENANCE AGREEMENT ENDS
Restoration of mason on the exterior of the Lafayette Building
The work under the above contract between the City of South Bend and the undersigned contractor having been completed,
the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or
by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City
of South Bend which were a part of the above Contract.
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Executed this l day of 7:�L.+J-1-'- 201 91 C&S-MasonEy Restoration, LLC.
Company Name
Signature 3725 N. Foundation Ct., Suite AB
Company Address
Printed Name
South Bend,„ IN 46628
City, State, Zip z N
WITNESSESS: o a
Before me _,the undersigned Notary Public in and for said country and state, personally appeared m o
_tJ and acknowledged his/her signature to the above Project Completion Affidavit of ;°�
the /0 daX of 1201Le �.
L / Q X�.
Notary Signature My Commission Expires
Printed Name County of Residence
If the Contractor is a corporation, the following certificate will be executed.
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I, certify that I am Secretary of the Corporation executing this release; that
who signed this release on behalf of the contractor was then
of said Corporation; that said release was duly signed for and on behalf of said
Corporation by Authority of its governing body, and is within the scope of corporate powers:
Secretary's Signature
Printed Name
Corporate Seal
DEPARTMENT OF PUBLIC WORKS APPROVAL
This project is acceptable fohi I approval and we recommend to the Board of Public Works that it be ordained so.
Date: l
Construction ger
BOARD OF PUBLIC WORKS APPROVAL Date:
An (0
Gary A. Gilot, President Genevieve E. Miller, Member Elizabeth A. Waradik, Mem "er
Therese J. au,, Mefrrl5er Laura O'Sullivan, Member i d M Martin, I rk
AFFIDAVIT AND WAIVER OF LIEN
State of Indiana, County of S (- _W'O,6� _ SS:
being duly sworn that he/she is the
(Name of Officer) (Title)
( trhaving contracted with C t-�� O� S �-� �� �
of ►�' So or... _„ ... (C-,eaetei j�
to furnish certain materials and/or labor as follows:
for a project known as A,
located at
and owned by
(Description)
(Name of l,'
604A—T,-J ���L�v vo.ti✓�
(Owner)
and does hereby further state on the behalf of the aforementioned subcontractor/supplier:
(PARTIAL WAIVER) that there is due from the Contractor the sum of
Dollars
❑ receipt of which is hereby acknowledged; or
E] the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which is given
solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the
undersigned;
(FINAL WAIVER) that the final balance due from the is the sum of
f( _,.,....
_.:.. .. m..
❑ receipt of which is hereby acknowledged; or
the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall
become effective only upon receipt of such payment.
THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all liens or claims whatsoever
on the above -described property and improvements thereon an account of labor or material or both, furnished b the undersigned
thereto, subject to limitations or conditions expressed herein, if any; and further certified that no other party has any claim or right to a
lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this Affidavit
and Waiver of Lien.
By
(Authorized Representative)
STATE OF INDIANA )
SS:
ST. JOSEPH COUNTY ) /
Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared
and acknowledged the execution of the foregoing Affidavit and Waiver of Lien.
b 200 a ( al on the "% day of
. _ ,........._.. �.... scribed my name, and WITNESS WHEREOF I have hereunto subscribed y official se . � Mµ
�......X affixed m o
Notary Public Signature
My Commission Expires: ..�L......._..... _ MARSHA L. 11fi01
ResidingPublic, State of In?, a
County
of St losefi
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. County, _�_ ... _.�, _ wmmITm _ SEAL Notary Public Name
am mission 14 (441!74 2021
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 06/18/2019 Department Public Works
Name Toy Villa Division/Bureau Engineering
BPW Date 06/25/2019 Phone Extension 5920
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Required Prior to Submittal to Board
Legal ❑jl Attorney Name:
Controller ❑ Controller review is required for all Contracts $5,000.00 or more and
greater than one year in length per the City Purchasing Policy
Purchasing E
El Agreement Amendment
to
❑ Professional Services
❑ Bid Opening
❑ Quote Opening
Change Order No.
Ease/Encroach.
Ir1 Other:
iropriatewwItem Type —
F] Contract
El Resolution
❑ Bid Award
El Quote Award
�C/O &PCANo,
Traffic Control:
Company or Vendor Name
New Vendor
MBE/WBE Contractor
MBE/WBE Contractor Requested
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
Amount of F1 Increase
R Decrease
Previous Amount $
Current Percent of Change, %
New Amount $
..................
Total Percent of Change: %
Copy
Original
❑
Fl
❑
for All Submissions
1 Proposal
❑ Req. to Advertise
Reauired Information
Proiect Closeout
Addendum
❑ Title Sheet
❑ Required Contractor's Certification Forms Attached (Non -
Collusion, Non -Discrimination Non -Debarment, E-Verify, Iran etc.
uq fired For anrders 91y
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